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Cardiovascular > Pathology (Cardiovascular) > Flashcards

Pathology (Cardiovascular) Flashcards

1
Q

What are the 3 main types and 1 less main type of cardiomyopathy?

A

Restrictive, dilated and hypertrophic. Other is arrhythmogenic right ventricular dysplasia.

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2
Q

Describe what the heart looks like in dilated cardiomyopathy.

A

2 or 3 times normal size, flabby or floppy.

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3
Q

What are the histology features of dilated cardiomyopathy?

A

Non-specific.

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4
Q

What types of genetic mutation causes dilated cardiomyopathy?

A

Autosomal dominant, autosomal recessive, X-linked, mitochondrial.

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5
Q

The genes that encode for what proteins are mutated in dilated cardiomyopathy.

A

Heart muscle proteins like desmin, dytrophin (muscular dystrophy).

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6
Q

What are the other causes of dilated cardiomyopathy?

A

Toxins, alcohol (unknown if direct ethanol toxicity of nutritional deficiencies), doxorubicin (chemotherapy agent, assess heart prior to commencing chemotherapy).

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7
Q

What are 2 rare causes of dilated cardiomyopathy?

A

Cardiac infection and pregnancy.

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8
Q

What are the clinical features of dilated cardiomyopathy?

A

General picture of heart failure: SOB, poor exercise tolerance, low ejection fraction.

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9
Q

Describe what the heart looks like in hypertrophic cardiomyopathy?

A

Big solid hearts, hypertrophic.

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10
Q

What causes diastolic dysfunction in hypertrophic cardiomyopathy?

A

Heart cannot relax and eventually outflow obstruction due to left ventricular wall enlarging?

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11
Q

What is hypertrophic cardiomyopathy a cause of in athletes?

A

Sudden death.

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12
Q

What genes may be mutated in hypertrophic cardiomyopathy?

A

Beta myosin heavy chain, myosin binding protein, alpha tropomyosin.

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13
Q

What are the histological features of hypertrophic cardiomyopathy?

A

Disorganised myofibres.

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14
Q

What type of dysfunction does restrictive cardiomyopathy have?

A

Diastolic dysfunction.

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15
Q

Describe the heart in restrictive cardiomyopathy.

A

Stiff.

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16
Q

What happens to the atria as a result of restrictive cardiomyopathy?

A

Dilatation as a result of back pressure.

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17
Q

What are the causes of restrictive cardiomyopathy?

A

Deposition of something in the myocardium: metabolic byproducts e.g. iron, amyloid, sarcoid (granulomas), tumours, fibrosis following radiation.

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18
Q

What is amyloid?

A

Abnormal deposition of an abnormal protein.

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19
Q

What do the abnormal proteins in amyloid tend to form?

A

Beta pleated sheets.

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20
Q

How would you find out the cause of a restrictive cardiomyopathy?

A

Biopsy.

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21
Q

What are the classifications of amyloid?

A
  1. AA (related to chronic diseases like rheumatoid).
  2. AL (light chains, abnormal Ig).
  3. Haemodyalysis associated (beta 2 microglobulin).
  4. Diabetes.
  5. Alzheimer’s
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22
Q

Give an example of a type of amyloid that is isolated in the heart?

A

Senile cardiac amyloidosis.

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23
Q

What is they histological appearance of amyloid?

A

Waxy pink material, stains positively for congo red, exhibits apple green birefringence.

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24
Q

Where is amyloid often seen affecting at autopsy, and what does this cause in a living person?

A

The conduction pathway. Arrhythmogenic death.

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25
Q

What is arrhythmogenic right ventricular dysplasia and why is it hard to detect?

A

Right ventricle gets largely replaced by fat. The right ventricle always looks a bit fatty.

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26
Q

What is the type of genetic disease that gives you arrhythmogenic right ventricular dysplasia?

A

Autosomal dominant with low penetrance.

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27
Q

Is infective or non-infective myocarditis more common?

A

Infective.

28
Q

What are the most common infections in myocarditis?

A

Most are viral (Coxsackie A and B, ECHO virus, many others), Chaga’s disease (trypanosomiasis in S america), borrelia burgdorferi (lyme’s disease), HIV.

29
Q

What does the heart look like in infective myocarditis?

A

Thickened beefy myocardium.

30
Q

What will you see on histology of infectious myocarditis?

A

Inflammatory infiltrates.

31
Q

What causes non-infectious myocarditis?

A

Immune mediated hypersensitivity reactions e.g. hypersensitivity to infection (rheumatic fever after strep throat), hypersensitivity to drugs (eosinophilic myocarditis), systemic lupus erythematosus (SLE).

32
Q

What does rheumatic fever do to the heart?

A

Classic mitral stenosis with thickening and fusion of valve leaflets, short thick chordae tendinae, myocardium patchily inflamed.

33
Q

What will you see on histology of rheumatic fever?

A

Aschoff bodies (collage fibres and fibrinoid collagen necrosis, rheumatic granuloma).

34
Q

What are the causes of pericariditis?

A

Infection, immune mediated (rheumatic fever), idiopathic, uraemic (renal failure), post MI (Dressler’s syndrome), connective tissue disease e.g. SLE.

35
Q

What kind of virus is usually in infectious pericarditis and what type of effusion does it cause?

A

ECHO virus, serous effusions.

36
Q

What kind of bacterial infections are there in pericarditis and what type of effusion do they produce?

A

Extension from elsewhere e.g. pnuemonia. Purulent effusions.

37
Q

What kind of patients get fungal pericarditis and what type of effusion do they produce?

A

Immunosuppressed patients, post-transplant, produce purulent effusions.

38
Q

What sort of material will be produced in the pericardial sac in tuberculous pericarditis?

A

Caseous material (cheesy).

39
Q

What is Dressler’s syndrome?

A

Pericarditis post MI.

40
Q

How long after an MI does dresslers syndrome present?

A

Many weeks.

41
Q

What is assumed to be the cause of Dressler’s syndrome?

A

Assumed to be immune mediated: damaged heart muscle releases previously unencountered material that stimulates an immune response.

42
Q

What are the complications of pericarditis?

A

Pericardial effusion, tamponade, constrictive pericarditis, cardiac failure, death.

43
Q

How virulent an organism causes infectious endocarditis?

A

Very virulent (may be bacterial or fungal).

44
Q

What historically caused infective endocarditis?

A

Rheumatic heart disease.

45
Q

What nowadays causes infective endocarditis?

A

Prosthetic valves, congential defects, bicuspid valves, MV prolapse, calcific disease.

46
Q

What are the parts of the HACEK acronym for bacteria that cause infectious endocarditis?

A

Haemophilus, actinobacillus, cardiobacteria, eikenella, kingella.

47
Q

What type of infective endocarditis do IV drug users get?

A

Candida, staph aureus (on right side).

48
Q

What type of bacteria infects prosthetic valves?

A

Staph epidermidis.

49
Q

What causes vegetations on heart valves?

A

Bacteria excite acute inflammation, bacteria and inflammatory cell products digest into the valve leaflets.

50
Q

What are the cardiac complications of infective endocarditis?

A

Acute valvular incompetence, high output cardiac failure, abscess, fistula and pericarditis.

51
Q

What are all the systemic manifestations of infective endocarditis?

A

Osler’s nodes, Janeway lesions, roth spots, splinter haemorrhages, septicaemia, systemic septic emboli (brain, kidney etc), mycotic aneurysms.

52
Q

What are the causes of non-infective endocarditis?

A

Rheumatic fever, SLE, non-bacterial thrombotic endocarditis (marantic endocarditis), carcinoid heart disease.

53
Q

What is the effect of non-bacterial thrombotic endocarditis (NBTE) on heart valves?

A

Non-invasive and don’t destroy valves, small and multiple vegetations.

54
Q

What is NBTE associated with?

A

Cancer (marantic). Frequently mucinous adenocarcinomas. Also hypercoagulable states.

55
Q

What is endocarditis caused by lupus known as?

A

Libman-Sacks endocarditis.

56
Q

Describe Libman-Sacks endocarditis.

A

Small sterile emboli often under surfaces of valves or on chords.

57
Q

What are carcinoid tumours?

A

Neoplasms of neuroendocrine cells.

58
Q

Where can you find carcinoid tumours?

A

In any mucosa (common in GI tract and lung).

59
Q

What carcinoid tumours release?

A

Hormones.

60
Q

What is carcinoid syndrome?

A

Occurs when carcinoid tumour has spread to the liver.

61
Q

What causes the symptoms of carcinoid syndrome?

A

Excess 5HIAA, serotonin, bradykinin etc production by the tumour.

62
Q

What are the symptoms and complications of carcinoid syndrome?

A

Flushing; nausea, vomiting and diarrhoea; produces right sided cardiac valve disease; tricuspid and pulmonary insufficiency.

63
Q

Why are primary tumours of the heart very rare?

A

Cardiac muscle cells are end differentiated.

64
Q

What is the commonest primary tumour of the heart?

A

Atrial myxoma.

65
Q

What kind of secondary tumour affect the heart?

A

Metastatic malignant melanoma, direct invasions by carcinoma of lung, oesophagus.

66
Q

What type of tumour can cause ball/valve obstruction?

A

Atrial myxoma?

67
Q

What can atrial myxoma cause?

A

Tumour emboli, endocarditis, systemic fever and malaise.

Cardiovascular (32 decks)

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